a study to evaluate quality of nursing care practices …

European Journal of Molecular & Clinical Medicine

ISSN 2515-8260 Volume 08, Issue 03, 2021

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A STUDY TO EVALUATE QUALITY OF NURSING

CARE PRACTICES AND

PATIENT SATISFACTION AMONG

PARTURIENTS ADMITTED IN OBSTETRIC

UNITS OF A SELECTED TERTIARY CARE

HOSPITAL AT LUCKNOW

R. Padma Hepsiba, M.Sc. (N), M.Sc (Psy), M.B.A.(HA)

Ph D Scholar , NIMS University, Jaipur, India.

Co author : Dr. TAPTI BHATTACHARJEE,

PROFESSOR, College of Nursing, NIMS University, Jaipur, India

INTRODUCTION

The present study was undertaken to evaluate quality of nursing care practices and patient

satisfaction among parturient admitted in obstetric units of a selected tertiary care hospital at

Lucknow.

The objectives of the study were:

1. To assess the quality of nursing care practices provided to parturients admitted to the

obstetrics unit of a territory hospital at Lucknow.

2. To determine the maternal satisfaction level among parturients admitted to obstetric units of

a tertiary care center.

3. To associate the quality of nursing care practices with patient satisfaction in a selected

territory care hospital at Lucknow.

5. To associate the relationship between quality of nursing care practices and demographic

variables.

6. To associate the relationship between patient satisfaction and demographic variables.

7. To identify the gap in level of care in nursing services related to quality assurance

programme and patient satisfaction.

REVIEW OF LITERATURE

A review of literature is a systematic search work to gain information about a research

topic. Conducting a review of literature is a challenge and enlightening experience. Through a

literature review, researcher generates a picture of what is known already about a particular

situation and the knowledge gap that exists between the problem statement and the research

subject problems and lays a foundation for the research plan.



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The typical purpose for analysing or reviewing existing literature is to generate research question

to identify what are known and what are not known about the topic, to identify the conceptual of

theoretical tradition with in the bodies of literature and to describe methods of enquiry used to

earlier work including the success and short comings. The literature review was based on an

extensive survey of books, journals, PubMed, Research gate and Semantic scholar. A review of

research and non research literature relevant to the study was taken, which helped the

investigator to develop deeper insight into the problem and gain information on what has been

done in the past.

Here the review of literature related to the purpose of the present study has been divided under

the various heading like Literature related to Patient satisfaction with nursing care practices,

literature related to Quality Assurance and literature related to Nursing Audit. Few of them are

discussed below

a) According to Panneerselvam S, quality is the key component for every individual

in each aspect of life. In order to have the clientele satisfaction every organization

consider quality as an important aspect while planning their consumer services. Health

care industry having no exception strives to achieve this through quality nursing

services. Patient care using the nursing process model helps nurses to care for the

patients in a progressive manner. As the components include initial and ongoing

assessment, planning need based care, appropriate measures to implement and evaluate

the services. The author has also identified few issues like lack of professional ethics,

gender bias, staff shortage, unemployment and maltreatment at the workplace, which

may pose hindrance to the implementation of quality services and the outcome.

b) A quality survey done in Isreal analyzed, nursing care on four main aspects of

nursing process covering thirteen hospitals which included 119 med-surg wards among

2065 patients. Patient Classification Form to assess the dependency level and monitor to

measure level of nursing care in med-surg wards. Variables associated with quality of

nursing care were patient dependency, size of ward and hospital. The survey suggested

that maximum quality nursing care is associated with physical needs of patients and

minimum with assessment and planning of patient care. Then also dependency level

were the more difficult factor of all.

c) Dickey S Johnson BSN, Marijo Burkes MSN carried out a study from Oct to

Dec2010 Comparison was done between the manual charting and computerized charting

of vital parameters, IV infusions, oral intake and output details and medicine

administration among 50 samples. Duration of this study: 7 days of data collection in

the Pre-implementation phase, thereafter gap of 2 months permitted, implementation

phase, gap of five months and then post-implementation phase data collection. Through

this study it was identified that computerized charting method yielded more hours for



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patient care activities and change in the attitude of nurses towards use of computers and

definitely increased the charting quality.

d) Karaca.A, Durna Z conducted a descriptive survey in a Private Hospital among

635 in-patients on their discharge with an aim to assess patients’ level of satisfaction on

nursing care quality and the related factors. A 19-item questionnaire on the quality

nursing care and patient level of satisfaction along with a tool to obtain socio-

demographic and medical information. Result depicted that the subjects 63.9% were

much satisfied with the care and concern of nurses and least with the comprehensive

information provided by them. It revealed the fact that nurses need to take greater

initiative in providing information to the patients.

e) A study done among the in-patients of adult wards of the following departments;

Medicine, surgery and Gynaecology. The aim was to assess the experience of nursing

care and related factors. Convenient sampling method adopted and used a modified

version of Experience with Nursing Scale of Newcastle. Data analyzed using SPSS

version 16. Logistic regression done (Binary & Multiple) . Among 374 patients the

response rate was 100%. Above mean rating was found to be 90% , noteworthy

predictors were the type of job of patients (AOR:2.90) and the number of night stay of

the patients (AOR:0.26) in the hospital. One in ten patients under rated the nursing

experience hence need to be sensitized how to utilize the nursing services if they had to

stay longer in the hospital.

Table 1: Socio-demographic data

Parameters No of cases Percentage (n=600)

Age (Yrs) 18 – 20 49 8.2

21 – 25 298 49.7

26 – 30 169 28.2

31 & above 84 14.0

Religion Hindu 424 70.7

Christian 59 9.8

Muslim 100 16.7

Others 17 2.8

Educational status Primary 58 9.7

Secondary 131 21.8

Higher secondary 204 34.0

Graduate & above 207 34.5

Occupation Home maker 419 69.8

Private employee 112 18.7

Govt. employee 69 11.5

Income of family

(Rs)

<10000 8 1.3

10001 – 15000 55 9.2



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15001 – 20000 123 20.5

20001 & above 414 69.0

Type of family Nuclear 416 69.3

Joint 136 22.7

Extended 48 8.0

Type of diet Vegetarian 291 48.5

Non-vegetarian 248 41.3

Mixed 61 10.2

Place of residence Rural 378 63.0

Urban 222 37.0

Methodology:

Descriptive cross-sectional research study was conducted in Tertiary care hospital at Lucknow.

For evaluating the practices being followed in the nursing care using checklist, observation for at

least two-man hours per day was done for 08 months which was translated as 360 hours for 06

months. Purposive sampling was employed to recruit 600 mothers who got admitted in Maternity

ward for delivery services. Patient satisfaction questionnaire and checklists were selected for

data collection. Descriptive and inferential statistics were used for data analysis.

Tools to be used

a. Demographic data of parturients

b. Checklist to assess maternal satisfaction on interpersonal aspect of nursing care.

c. Checklist to assess maternal satisfaction on informative aspect of nursing care.

d. Checklist to assess maternal satisfaction on technical aspect of nursing care.

e. Observation checklist for ANC nursing care practice.

f. Observation checklist for intranatal nursing care practice.

Data Analysis :

The data analysis was planned to include both descriptive and inferential statistics. Frequency

and percentage distribution were used to describe socio-demographic variables and their

association with maternal satisfaction and quality nursing care. Chi square test was used to find

the association between quality of nursing care and maternal satisfaction.

Results:

13% of the sample was satisfied with the nursing care practices and 87% were partially

satisfied. Maternal satisfaction was assessed for attributes like interpersonal, informative and

technical aspect of nursing care. 71% of the nurses had good practice score on quality of nursing

care, 17% had average score and 12% had poor score. 72% of the nurses had good practice score

in ANC care, 15% had average score and 12% had poor score.70% of the nurses had good

practice score in intranatal nursing, 22% had average score and 8% had poor score. P value was

taken as 0.81 and chi value as 0.43. Maternal satisfaction and practice scores were also compared

to various demographic data.



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DISCUSSIONS :

With respect to assess the quality of nursing care practices provided to parturients admitted

to the obstetrics unit of a Tertiary Care Hospital at Lucknow. It was found that 71% had good,

17% had average and 12% had poor practice score on quality of nursing care. Also, 72% had

good, 15% had average and 13% had poor practice score on ANC nursing care, whereas, 70%

had good, 22% had average and 8% had poor practice score on intranatal nursing care.

With regard to determine the maternal satisfaction level among parturients admitted to

obstetric units of a tertiary care center, it was found that the study results show that 13% of

parturients were satisfied and 87% were partially satisfied. Also, 20.8% were satisfied, 77.3%

were partially satisfied and 1.8% were not satisfied with interpersonal aspect of nursing care.

Similarly, 9.5% were satisfied, 90.5% were partially satisfied with informative aspect of nursing

care. In addition, 33% were satisfied and 66% were partially satisfied with technical aspect of

nursing care.

With regard to the quality of nursing care practices with patient satisfaction it was

discovered that 71% found the quality of nursing care good, out of which 12.4% were satisfied

and 87.6% were partially satisfied with nursing care. 17% found the quality of nursing care

average, out of which 14.7% were satisfied and 85.3% were partially satisfied with nursing care.

12% found the nursing care poor, out of which 13.8% were satisfied and 86.2% were partially

satisfied.

With regard to the relationship between the quality of nursing care practices and

demographic variables, it was seen that there is no association between quality of nursing care

practices and demographic variables. Hence, there is no significant relation between quality

nursing care in delivery room with selected demographic variables. There is no significant

relation between mother’s satisfaction in delivery room with selected demographic variables.

Hence, H0 was acceptable.

CONCLUSION:

The study concluded that there is no association of maternal satisfaction and quality of nursing

care with socio-demographic variables. Also, it is revealed that parturients are mostly partially

satisfied with interpersonal, informative and technical aspects of nursing care.

The study recommended that nurses have a pivotal role in care of parturient and they should be

motivated to enhance their quality of care and practice in labour room.

ACKNOWLEDGEMENT

“In all your ways acknowledge Him, and He shall direct your paths”.

Proverbs 3:6

I am grateful to Almighty for His blessings and grace throughout my study without which

nothing would have been possible. It is with great pleasure and deep satisfaction I owe my sense



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of gratitude to many around me who contributed towards the successful completion of my

dissertation.

I extend my grateful acknowledgment to all the experts in the field of nursing, for

validating the tool and for their valuable contribution. My heartfelt thanks to my subjects who

willingly participated in the study without whom I would not have completed this study.

My expression of heartfelt gratitude in ample measures to my husband Mr. Gnana

Pragasam, my son Lt Cdr Paul Moses, for their constant support, motivation and blessings

which enabled me to complete this study successfully. Very special thanks to all my well wishers

and many others who have helped me directly and indirectly in the preparation of this

dissertation.

REFERENCE

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health sciences and research. 2017 Dec :7(12)

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6:535–45.

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nursing care in Ethiopia: a systematic review and meta-analysis. BMC Nurs. 2019:

18(27)

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Associated Factors Among Adult Inpatients in Black-Lion Hospital, Addis Ababa,

Ethiopia : An Institution-Based Cross-Sectional Study. J Nurs Care 3(165).

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Areas of Tertiary Care Hospital. Intl J of health sciences and research. 3(2):150-61.

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584-90.

Available from Wiley Online Library-

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kattankulathur. Intl J of Pharm and Cli Res. 7(6): 458-61.



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Selective Academic Hospitals. Int J Collab Res Intern Med Public Health.2012: 4(10):

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Departments of Bale Zone Hospitals,Oromiya Regional State, Southeast Ethiopia

Facility-Based Cross Sectional Study. Quality in primary care; 2016

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of Health Care: A Literature Study. Scand J Caring Sci. 2000 Dec: 16(4):337-34

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Table 2: Socio-demographic data

Parameters No of cases Percentage (n=600)

Birth order of

present

pregnancy

One 246 41.0

Two 234 39.0

Three 107 17.8

Four & above 13 2.2

No of live

children’s

No 298 49.7

One 231 38.5

Two 56 9.3

Three & above 15 2.5

Sources of

pregnancy

related

information

Newspaper / Magazine /book 30 5.0

Electronic sources 201 33.5

Friend/neighbor/relative/family

members 183 30.5

Health personnel 186 31.0

Duration of

pregnancy

(Weeks)

36 – 37 454 75.7

38 – 39 119 19.8

40 19 3.2

Above 40 8 1.3

Associated

health

problems

Respiratory 36 6.0

Neurological 6 1.0

Hormonal 48 8.0

Others 510 85.0

Maternal satisfaction No of cases Percentage

45 – 105 (Satisfied) 78 13.0

106 – 165 (Partially satisfied) 522 87.0

166 – 225 (Not satisfied) 0 0

Total 600 100.0



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Table 4: Assess the maternal satisfaction level on interpersonal aspect of nursing care in

study group


15 – 35 (Satisfied) 125 20.8


56 – 75 (Not satisfied) 11 1.8

Total 600 100.0

0

10

20

30

40

50

60

70

80

90

100

45 – 105 (Satisfied) 106 – 165 (Partially satisfied)

166 – 225 (Not satisfied)

% o

f ca

ses

Maternal satisfaction score

0

10

20

30

40

50

60

70

80

90

100



% o

f ca

ses




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Table 5 : Assess the maternal satisfaction level on informative aspect of nursing care in

study group


20 – 46 (Satisfied) 57 9.5



Total 600 100.0

Table 6 : Assess the maternal satisfaction level on technical aspect of nursing care in

study group


10 – 23 (Satisfied) 204 34.0



Total 600 100.0

0

10

20

30

40

50

60

70

80

90

100



% o

f ca

ses




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Table 7: Assess the practice score on quality of nursing care in study group

Practice score No of cases Percentage

0 – 15 (Poor) 72 12.0

16 – 30 (Average) 102 17.0

31 – 46 (Good) 426 71.0

Total 600 100.0

0

10

20

30

40

50

60

70

80

90

100



% o

f ca

ses


0

10

20

30

40

50

60

70

80

90

100

0 – 15 (Poor) 16 – 30 (Average) 31 – 46 (Good)

% o

f ca

ses

Practice score



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Table 8: Association between quality of nursing care and patient’s satisfaction in study

group

Maternal satisfaction Quality of nursing care Total

0 – 15 (Poor) 16 – 30 (Average) 31 – 46 (Good)

45 – 105 (Satisfied) 10 15 53 78

106 – 165 (Partially satisfied) 62 87 373 522

166 – 225 (Not satisfied) 0 0 0 0

Total 72 102 426 600

Chi-square = 0.43, P=0.81

0

20

40

60

80

100



% o

f ca

ses


Quality of nursing care 0 – 15 (Poor) Quality of nursing care 16 – 30 (Average)

Quality of nursing care 31 – 46 (Good)

a study to evaluate quality of nursing care practices …

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